Complication Profile of Open Calcaneal Fractures: A Systematic Review of Vascular Injury Reporting and Clinical Outcomes

Open calcaneal fractures are rare, high-energy injuries associated with severe soft tissue damage and a high risk of complications. This systematic review evaluated complication patterns and vascular injury reporting in open calcaneal fractures. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided search of PubMed, Embase, Scopus, and the Cochrane Library identified four eligible studies, including a total of 455 patients. Data were extracted on vascular injury, infection, amputation, reoperation, and functional outcomes, and a narrative synthesis was performed due to heterogeneity. Posterior tibial artery injury was reported in limited cases, while dorsalis pedis artery injury was not documented. Overall complication rates were high, including superficial infection up to 9.6%, deep infection up to 12.2%, osteomyelitis at 5.2%, and amputation rates between 5% and 8%. One large cohort reported wound-related revision in nearly half of the cases. Vascular assessment was inconsistently reported and rarely supported by imaging. These findings highlight a significant complication burden and a persistent gap in the standardised evaluation of arterial injury in open calcaneal fractures.